Meal-Plan Myths Revealed
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Myth: Sugar is forbidden, but sugar-free foods are free
Fact: I'm not a big sweets eater. But when there's a family birthday cake, I don't want my sad, deprived face spoiling the fun. So I trade my potato for a small dessert because the carbs in sugar get processed just like the carbs in potatoes. True, potatoes and other vegetables, fruits, and dairy products deliver vitamins, minerals, and energy that protect my health, so those are mostly what I eat. But to help me avoid feeling deprived, I allow myself the occasional sweet treat.
Many so-called sugar-free foods (such as cookies or candy) often aren't free because they have carbs from flour or milk. Some are made with sugar alcohols such as maltitol or sorbitol. "People with diabetes absorb about half the carbohydrate listed as sugar alcohol," says Gillian Arathuzik, R.D., CDE, a diabetes nutrition educator from the Joslin Diabetes Center in Boston. So if the label says 10 grams of sugar alcohol, count it as 5 grams of carbs. And be aware that large amounts can cause diarrhea or gas.
Myth: Eating healthful carbs will control blood glucose
Fact: All carbs matter, says Becky Abel, R.N., CDE, director of the diabetes self-management center for the LHC Group in Lafayette, Louisiana. One of Abel's patients with high blood glucose was shocked to learn that her daily tropical fruit smoothie packed 126 grams of carbohydrates -- eight carb servings! Sure, it was made with healthful fruit, but good-for-you ingredients don"t negate the carbs. Healthful trail mix, whole grain cereals, and sweet potatoes supply nutrients, but they're packed with carbs, too, and your body is aware of every one. In a curious moment, I weighed some apples and oranges. Most had 25 to 30 grams of carbs, equaling two servings of fruit, not one. Yikes! So I started buying bagged fruits, which are often smaller. Weighing and measuring portions really helps. With practice, you'll get better at knowing what a serving looks like. The moral of this story: Count the carbs -- all the carbs.
Myth: Carbs are off the menu
Fact: About half of your calories should come from carbs. My pendulum has swung from "carbs are king" (during my marathon-running days) to cutting carbs now that my activity is in the normal range. Drastically cutting my carbs left me tired, cranky, and too listless to hit the gym. So I started using the American Diabetes Association's recommendation of 40 to 65 percent of daily calories from carbs. The general starting point for a woman my size is 45 to 60 grams of carbs at each meal (For men, 60 to 75 grams of carbs per meal is suggested). What's right for you? Check with a registered dietitian. By the time I got to 50 percent of my calories from carbs, my energy returned, I enjoyed the gym, and my A1C was under 6 percent. And instead of counting all the food groups, I focus on the fruits, starches, and dairy items. By eating about the same number of carb grams at each meal, my energy level stays up and my blood glucose stays on target.
Myth: All white foods are bad
Fact: There's no such thing as "bad" versus "good" carbs. The low-carb dieting craze has triggered persistent "bad carb" rumors. Carrots, beets, bananas, and anything white have been falsely accused of raising blood glucose higher than other carb sources. While whole grains, such as brown rice, deliver more fiber and are smarter nutritional options than processed grains, their effect on blood glucose is about the same as long as you get the portions right, Abel says. For the best nutrition, however, regularly choose carbs that offer the most benefits: vegetables, fruits, legumes, whole grains, and low-fat dairy foods.
Myth: Diabetes controls you, and you have to give up your life and dreams
Fact: Options abound to help you stay flexible and live the life you want. There were a few months when I felt like the walls were closing in and there was nothing I could eat. Then I got a blood glucose monitor and started testing to see how my meals and carbs affected me. The more I learned about my personal response to food, the easier it became to eat with family and friends, enjoying the same foods they do, although sometimes in different proportions. A dietitian can help you work with your favorites. In the heart of Cajun country, for example, many people eat white rice twice a day and just don't like brown rice.
"The best way to help is to teach people how to eat the foods they love," says Abel, who works with patients on portion sizes. If your white or brown rice serving is 1⁄3 cup, measure it level -- not a "pregnant" (rounded) third, she says.
Nutrition knowledge and portion practice are powerful. "You can still do anything you want to do. You just have to learn how," says Janis Roszler, R.D., CDE, of diabetes support site dearjanice.com. During the past year, both my understanding about healthful eating and what I've actually put in my mouth have improved.
Myth: Test once a day after fasting to monitor blood glucose
Fact: Test three times a day to get a better picture.
When I first learned that my fasting glucose was rising, I envisioned sky-high numbers all day long. How wrong I was! With more frequent testing, I learned that, at least at this stage of the game, only my fasting glucose is high -- as long as I set reasonable limits on my carbs, and especially when I choose slow-releasing grains such as oatmeal and barley.
"We recommend testing three times a day -- first fasting, then before and after the largest meal -- to get a more complete picture," says Diane Reader, R.D., CDE, manager of diabetes professional training at the Park Nicollet International Diabetes Center in St. Louis Park, Minnesota. Because blood glucose values rise and fall all day long, testing at different times fills in the blanks with facts, not guesses.
Myth: You have to eat your meals at the same time every day
Fact: Meal times can vary.
OK, I didn't need a glucose meter to figure out this one. Still, I felt relieved when Arathuzik confirmed it for me: "With type 2 diabetes and no meds, meal times are flexible." So far, my body is still making insulin and glucagon, the two hormones that keep my blood glucose steady (as long as I stick to the number of carb servings in my eating plan). So if I lose myself in work and don't get to lunch until 1:30 p.m. instead of noon, my body can still keep my blood glucose levels steady. If someday I need oral medications or insulin, it will be another story, since some can cause low blood glucose that my body can't correct by itself. But for now, I can go with the flow.
Myth: All meals should have the same amount of carbs
Fact: Finding your own "carb threshold" gives you more flexibility and control.
In the old days, I learned to design meal plans where the carbs were the same for every meal. Then, at a workshop sponsored by Vanderbilt University in Nashville, Tennessee, I got a surprise. "Insulin sensitivity can be different at different times of the day, and it may vary from day to day," says Dianne Davis, R.D., CDE, a presenter at the workshop. It's often worse in the morning, perhaps because of overnight inactivity, then improves as the day goes on when you're more active.
So maybe I can only tolerate three carb servings at breakfast, but by dinnertime I might be able to handle four or five. Here's where the glucose meter comes in handy. "You can determine how much carb a patient with type 2 diabetes can handle at a meal by monitoring before and two hours after several meals that occur at approximately the same time each day," Davis says.
I tested this out. Now I'm not overloading at breakfast, and I can add a small dessert after dinner without giving up my potato. Cool!
Myth: You need several snacks a day, especially before bed
Fact: Snacks are a thing of the past.
It used to be true that with the older types of insulin you might need a snack to prevent low blood glucose. "Things are different now because of the way the new insulins work," says Valerie Waldoch, R.D., of the Mayo Clinic in Rochester, Minnesota. "If you have type 2 diabetes, take oral medications, and have low blood glucose at random times, you don't need a snack. You need to lower your meds," Waldoch says. (Check with your health-care professional first, of course.) But people with type 2 diabetes and no meds have never needed snacks. And snacks can be an issue with weight control. If you keep adding snacks to your three-meal-a-day plan, you're just adding calories, which can cause weight gain, increase insulin resistance, and hamper blood glucose control. Most of us eat three meals a day and have to learn to do something else in between, like go for a walk or play the piano. If your weight is good and you get hungry between meals, you can fill in with a noncarb snack such as raw vegetables, cottage cheese, unsalted nuts, or a cheese stick -- but the calories still count.
If you're a grazer, you can divide your carbs and calories into smaller portions. "Six meals are great as long as you don't eat too many calories," Reader says. "They don't raise postmeal glucose very much, which is one of the main goals. Still, check you blood sugar two hours after the largest meal."
Myth: As long as I count my carbs, I don't have to worry about fat
Fact: High-fat meals can keep blood glucose high.
Hungry, I went looking for a snack low in salt (because of my blood pressure) and low in carbs (because of my blood glucose). I found a bag of natural almonds, and I ate too many. I didn't get hungry again for a long, long time, but when I checked my blood glucose in two hours, it was high but not off the charts. Curious, I checked again an hour later and it was still up there. Hmmmm....
Adding an extra-large dollop of fat slows down digestion, so the whole meal is absorbed more slowly. "Testing two hours after a high-fat meal may not yield the peak glucose," Davis says. Fat causes blood glucose to rise more slowly and stay high longer, she says. Sticking with a low-fat diet helps keep blood glucose manageable and calories under control.